Eustachian tube function in tympanoplasty

This paper describes central and peripheral eustachian tube function in relation to tympanoplasty. Central obstruction of the eustachian tube at the pharyngeal orifice is frequently correctable and is not a contraindication to tympanoplasty, whereas chronic cicatricial peripheral obstruction of the eustachian tube at the isthmus is a contraindication to tympanoplasty. These findings are based on tubal patency pressure studies measured with a mercurial manometer with the patient performing the Valsalva maneuver, with catheterization of the eustachian tube, and with politzerization. If the patient can autoinflate the middle ear and if the eustachian tube will open with politzerization, then the likelihood exists that there is no peripheral obstruction of the eustachian tube and you have a good candidate for tympanoplasty. When there is a perforation of the ear drum, the best test for eustachian tube function is microscopic examination of the middle ear mucosa. If the middle ear mucosa is perfectly normal, then you know that you have good eustachian tube function and can proceed with the tympanoplasty.     

Eustachian tube function during pregnancy

The upper respiratory mucosa has been reported to react to sex hormones in both physiological and pathological conditions. The present study was specifically aimed to determine the influence of high levels of oestrogen on Eustachian tube function. Fifty-three healthy, pregnant women were prospectively evaluated for Eustachian tube function during pregnancy. Eustachian tube function was found to be highly variable in different women, and in the same woman at different stages of pregnancy. We did not find a specific trend in Eustachian tube function with increasing oestrogen levels as encountered during pregnancy.     

Eustachian tube function of adhesive tympanum--pre and post operative evaluation]

We examined the eustachian tube function of 48 patients with adhesive tympanum who had undergone operations. Preoperative tubal openings were observed and determined in 57% of these cases by the dynamic movement of the tympanic membrane, 35% by the impedance method, and 74% by the sonotubometry and was found to be lower than in healthy subject. Furthermore the tubal opening duration in sonotubometry was significantly shortened in patients with adhesive tympanum as compared to healthy subjects. However, in a few cases of adhesive tympanum, tubal opening was prolonged remarkably, and indicated a mixed tendency of stenotic and patulous types. Postoperative tubal opening was not seen in 90.9% of the cases as determined by the inflation-deflation test. Mucociliary function was poor in 81.3% of the cases. No remarkable differences were seen between cases of total adhesion and those of posterosuperior quadrant adhesion by any method. The condition of the tympanic membrane and the tympanic cavity after operation, and the eustachian tube function were not correlated in some cases and indicated possible involvement of other factors.     

Eustachian tube function in children.

Eustachian tube function of children with bilateral serous otitis media was studied in 14 ears following myringotomy and pressure equalizing tube insertion. Cases with non-Eustachian tube pathology potentially contributing to Eustachian tube dysfunction were excluded from the study. Eustachian tube function was evaluated utilizing an impedance audiometer to document neutralization of positive and negative middle ear pressures. All cases showed persistent tubal dysfunction for up to six months. Partial incomplete neutralization of positive pressure occurred in 64 per cent, but in no case could negative pressure be partially neutralized even when "locking" was relieved with valsalva. Continuous ventilation of the middle ear for up to six months did not allow a return to normal Eustachian tube function. This is extremely effective palliation, and should be recognized as such.     

Eustachian tube function after transmyringeal ventilation

This study anus at determining the effect of transmyringeal ventilation on Eustachian tube functions. Seventy ears clinically diagnosed as having otitis media with effusion or grade I and II retraction of pars-tensa of tympanic membrane were treated with antiallergics, decongestants, mucolytics, and antibiotics as required for maximum upto three months. In forty-five ears that showed neither symptomatic nor audiometric improvement, transmyringeal ventilation was restored by myringotomy and ventilation tube insertion. There after, Eustachian tube functions were assessed by using pressure equilibration test. The post-operative audiograms showed mean hearing gain of 16. 6 dB (S D±7.9) in majority (96%) of the ears. At first week 93% ears could not either totally or partially equilibrate positive or negative pressure. The percentage in the poor function group remained 91% even at the end of 6 months showing no significant effect of ventilation tube insertion on active ET functions.     

Tympanoplasty and Eustachian tube function*

In an attempt to assess the value of preoperative tubal testing in the selection of cases most likely to respond favourably to surgery, 100 ears with a central perforation following chronic otitis media were investigated. Tubal function was tested manometrically with different known tests. Postoperatively the healing and hearing results were correlated with the preoperative test results. No positive correlation was found between healing or hearing and tubal function. Postoperatively 50 ears were re-tested in a pressure chamber with a flow volume technique. It was found that the tubal function improves postoperatively in spite of no visible pathological changes in the aural end of the tube. Possible explanations are offered.     

鼻内镜下腺样体吸切术对咽鼓管周围组织的处理

目的总结鼻内镜下腺样体吸切术在处理咽鼓管咽口周围结构的临床经验。方法回顾分析26例腺样体肥大伴分泌性中耳炎的临床疗效。着重探讨对咽鼓管扁桃体和咽鼓管圆枕后方肥大淋巴组织的处理方法。结果鼻内镜下腺样体吸切术术后治愈率和好转率较常规腺样体刮除术高(P<0.05)。结论鼻内镜直视下用弯头外侧开口吸切头经口腔入路切除腺样体对于清除咽鼓管周围淋巴组织具有明显优势,对于改善咽鼓管通气功能甚为重要,而且降低了咽鼓管咽口损伤的可能。     

分泌性中耳炎咽鼓管功能障碍的临床观察

目的：分析成人分泌性中耳炎咽鼓管主动和被动开放功能,方法：以正－负压平衡试验法,检测34耳外伤性鼓膜穿孔和57耳分泌性中耳炎鼓膜切开后的咽鼓管功能。结果：外伤性鼓膜穿孔耳的咽鼓管开放压分布在175－400kPa间,正压平衡试验时,经3次吞咽全部受检耳外耳道压力都降至所加压力的一半以下,负压平衡试验时,全部受检耳外耳道压力都有部分恢复。在57耳分泌性中耳炎耳中,咽鼓管开放压超过400kPa的11耳;正压平衡试验时,23耳不能恢复到压负荷的一半水平,负压平衡试验时,45耳经3次以上吞咽,外耳道鼓室压基本无变化。结论：成人分泌性中耳炎的咽鼓管功能,以负压平衡试验障碍为主,表现为主动开放功能不良。     

Therapeutic improvement of Eustachian tube function: a review

An impaired Eustachian tube is assumed to be an important factor in the pathogenesis of different middle ear diseases. Therefore, several investigators have studied different treatment strategies to improve Eustachian tube function. The aim of this review is to provide a comprehensive summary of the results of these studies on improvement of tubal function. The English language literature was searched systematically to identify all articles that described the effect of different interventions on Eustachian tube function. Although the results were not uniform throughout the different studies and despite several restrictions of the reviewed studies, the results of this review indicate that the function may be improved by medical intervention. However, it seems premature to recommend any of the interventions reviewed in this paper to improve function in humans. More studies, preferably randomized, placebo-controlled trials, should be conducted to assess the efficacy of different interventions.